| ObjectiveAs a common unfavorable prognosis of acute pulmonary embolism(APE),the recurrence of embolism leads to the increase in the social and family medical burden while seriously reducing the quality of patients' life.Early identification of factors related to the pulmonary embolism recurrence is of great significance to the development of individualized anticoagulation methods and the improvement of patient's prognosis.Therefore,this study aims to explore the predictive factors of APE recurrence.MethodsA total number of 169 patients diagnosed with APE for the first time at the Department of Respiratory and Critical Care Medicine of General Hospital of Tianjin Medical University from January 2014 to December 2015,were followed up and observed for the first two years after the initial diagnosis.General information of patients were retrospectively analyzed,and the potential risk factors were collected.The follow-up visits of anticoagulation time course,the count of the recurrence rate of APE and statistical analysis of the recurrence rate of APE were conducted.According to the recurrence of pulmonary embolism,the patients were divided into two groups,recurrence group and non-recurrence group.The univariate analysis of the predictive factors was performed prior to the multivariate analysis of two groups with significant difference.Finally,independent risk predictors related to the APE recurrence were obtained.ResultsAfter two years follow-up visits of 169 APE patients,a total of 23 patients had recurrence and the probability was 13.6%.In the non-recurrence group,sixty-nine(47.3%)were females,seventy-seven(52.7%)were males,and the average age was(58.17±14.00).Meanwhile,eleven(47.8%)were females and twelve(52.2%)were males in the recurrence group with the average age of(63.60±13.19).It was found that there was no significant difference in the gender between the recurrence group and the non-recurrence group(P>0.05).The average age and BMI index in the recurrence group of APE were to a certain degree,higher than that of the non-recurrence group.However,these two basic characteristics of the population had no significant effect on the recurrence of APE(P>0.05);Risk factors and/or comorbidities appeared to have statistical significance between the two investigated groups(P < 0.05),such as severe lung disease,long-term bedridden,malignant tumor,immune system disease,idiopathic pulmonary embolism and persistent anomaly of D-dimmer,suggesting the correlation of these factors with the recurrence of APE.Other risk variables such as recent surgery or trauma history,lower extremity DVT,hypertension,diabetes,pregnancy,resistance,coagulation of less than three months,exerted no marked influence on the recurrence of APE(P>0.05).Ultimately,by using multivariate regression analysis,independent risk predictors were screened for the patients with recurrence of pulmonary embolism as follows: malignant tumor(OR=8.384,P=0.003),immune system disease(OR=5.353,P=0.038),idiopathic pulmonary embolism(OR=10.609,P=0.001).However,the three dependent variables of long-term bed rest,severe lung disease,and persistent D-dimer were not statistically significant in the multivariate regression analysis(P>0.05).ConclusionPatients with acute pulmonary embolism showed a high probability of embolism recurrence.In the study,six kinds of potential risk factors were closely related to APE recurrence,including severe lung disease,malignant tumors,immune system diseases,idiopathic pulmonary embolism,persistent D-dimer,etc.In particular,associated malignant tumors,immunity.Systemic disease and idiopathic pulmonary embolism were independent predictors of recurrence in patients with APE.In order to minimize APE recurrence,risk and benefit assessment of the independent risk in the patients and proper extension of duration of their anticoagulant therapy should be taken into consideration.Overall,identifying independent risk predictors of APE recurrence as early as possible is of great significance to the set of individualized anticoagulation time interval,reduction in mortality,and improvement of patient prognosis. |
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